Stroke More Prevalent in U.S. Than in Europe

Americans have a significantly higher prevalence of stroke than their European counterparts, possibly because of additional risk factors and barriers to health care faced by those in the United States, says a new study.

Compared with European men, U.S. men had 61 percent higher odds of having a stroke, and U.S. women had almost twice the chances of having a stroke as European women, according to the findings  presented at the American Stroke Association’s International Stroke Conference 2008, in New Orleans.

"Most of this gap is among relatively poor Americans who were, in our data, much more likely to have a stroke than poor Europeans, whereas the gap in stroke prevalence is less marked between rich Americans and rich Europeans," study author Mauricio Avendano said in a prepared statement.

Researchers studied data on 13,667 people in the United States and 30,120 individuals in 11 European countries. The analysis included stroke occurrence, socioeconomic status, and major risk factors for stroke including obesity, diabetes, smoking, physical activity and alcohol consumption.

The age-adjusted prevalence rate of stroke varied considerably across countries. It was highest in the United States and lowest in the southern European countries of Spain, Italy and Greece, as well as Switzerland.

Higher stroke prevalence was associated with lower socioeconomic status as measured by wealth, income and education, but these associations were stronger in the United States than in most European countries. "Prevalence" is an estimate of the total number of cases of a disease existing in a population during a specified period.

Policies related to nutrition and transportation may also make Americans more prone to less physical activity and less healthy diets than many of their European counterparts, said Avendano, a research fellow in public health at the Erasmus Medical Center in Rotterdam, The Netherlands. This includes health-care access, which is universal in Europe but not in the United States, and "the preventive orientation of some European systems aimed at tackling stroke risk factors, as opposed to the U.S. health-care system, which focuses more on treatment and may actually be more successful in keeping stroke cases alive."

The study is based on 2004 data from the U.S. Health and Retirement Survey (HRS); the Survey of Health, Aging and Retirement in Europe (SHARE); and the English Longitudinal Study of Aging (ELSA).

Presented at the American Stroke Association’s International Stroke Conference 2008, in New Orleans.

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